Provider Demographics
NPI:1063220499
Name:BRYCE, JOSEPH RONALD
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RONALD
Last Name:BRYCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 WILSON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6241
Mailing Address - Country:US
Mailing Address - Phone:469-245-9000
Mailing Address - Fax:
Practice Address - Street 1:3321 WILSON AVE APT 1
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6241
Practice Address - Country:US
Practice Address - Phone:469-245-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program